A new study led by Brown University researchers finds that ophthalmology residents across the U.S. face a substantial burden of burnout and depression, which may affect not only the residents themselves but also the quality of care they deliver to patients.

The study, which involved a survey of ophthalmology residents completing their graduate medical training in health care settings across the nation, suggests there are ample opportunities for the specialty's residency programs to improve and promote wellness initiatives, from nutritional seminars to exercise classes to one-on-one counseling, and make them more accessible.

A majority of the survey's respondents -- 68 percent -- reported problems with depression, burnout or suicide in their residency programs within the past year. Survey results indicate that hospitals can do a lot more to support residents on a systemic level, not just by offering a variety of wellness programs but also by ensuring residents have enough free time to take advantage of them, authors say.

The results were published in JAMA Ophthalmology.

"Physicians in training are the future of our health care system, and there has been a recent push to boost support of them through wellness initiatives," said lead author Elaine Tran, a fourth-year Brown undergraduate. "Yet the resident wellness program landscape in ophthalmology has not been well documented in research literature."

Tran and others at Brown, including Professor of Ophthalmology Paul Greenberg, first sought to study the issue in 2016, when they received an Undergraduate Teaching and Research Award (UTRA) from Brown to survey ophthalmology resident program directors about wellness initiatives. A quarter of respondents to that initial survey, for which Greenberg was the lead author, reported issues with resident burnout, depression or suicide, and just half said their departments had resident wellness programs.

"After hearing from program directors, we recognized that a comprehensive analysis of residency-based wellness initiatives would be incomplete without also soliciting the resident perspective," Tran said.

With funding from a second UTRA from Brown, Tran, Greenberg and others devised another survey that went to more than 1,000 ophthalmology residents across the country. When asked what most hindered their participation in wellness programs, 25 percent of the 241 respondents cited a lack of time, while 16 percent cited the duration or scheduling of their shifts. Other major barriers reported were academic stressors, paperwork and administrative requirements, and understaffing at clinical sites.

Though training to become an ophthalmologist is necessarily challenging, Greenberg said, it is also in the best interest of residency programs to not only provide and promote wellness programs but also to help residents retain time in their schedules for wellness.

"We need to make sure we do everything we can to help residents achieve a healthy work-life balance," he said. "Residents who are burned out are not going to be as effective. We're not only looking to improve the quality of resident education, but also the quality of care we provide to our patients."

Greenberg and Tran both noted that big changes to resident wellness programs may be ahead. Last summer, while Tran and colleagues were creating their resident survey, the Accreditation Council for Graduate Medical Education (ACGME) released a revised set of requirements mandating that ophthalmology residency programs provide activities that promote resident well-being, encourage residents to pay attention to work intensity, and permit residents to attend personal health appointments.

"We believe that if there is greater partnership between local graduate medical education leaders and national organizations such as ACGME in promoting wellness, a lot can be done to better support residents on a systemic level," Tran said.

Tran, who is halfway through Brown's eight-year Program in Liberal Medical Education, hopes to survey ophthalmology residents and program directors again in a few years to find out whether the revised ACGME requirements helped lessen burnout and depression.

Greenberg said landing a paper in an American Medical Association journal is challenging for any researcher, let alone an undergraduate, and it's likely that the quality and significance of Tran's work were major factors in the paper's acceptance.

"Resident wellness is at the front and center of the concerns all medical educators have, and ophthalmologists are no different," he said. "We need more information about wellness programming from all the stakeholders, including program directors and residents, and we hope our study can help contribute to this goal."

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